David Best PhD, Senior Lecturer, Michael Gossop PhD, Head of Research, Lan-Ho Man BA, Researcher, Garry Stillwell MSc, Research Sociologist, Ross Coomber PhD, Principal Lecturer, John Strang FRCPsych, MD, Clinical Director, National Addiction Centre/Institute of Psychiatry, 4 WindsorWalk, Denmark Hill, London, SE5 8AF, UK. Correspondence to Dr David Best, Police Complaints Authority, 10 Great George Street, London, SW1P 3AE, UK. Received 20 August 2001; revised version 26 November 2001; accepted for publication 29 November 2001. Peer overdose resuscitation: multiple intervention strategies and time to response by drug users who witness overdose DAVID BEST, MICHAEL GOSSOP, LAN-HO MAN, GARRY STILLWELL, ROSS COOMBER & JOHN STRANG National Addiction Centre/Institute of Psychiatry, London, UK Abstract One hundred and thirty-five drug users in contact with treatment services in Scotland and England were interviewed about their experiences of witnessing overdosesÐboth overdoses resolved successfully and those leading to deathÐand actions taken to effect resuscitation. One hundred and four (77%) had witnessed a mean of 11.5 overdoses, of whom 41 (30.4% of the study sample) had witnessed an average of 4.2 fatal overdoses. A wide range of actions was reported at the most recent witnessed overdose, the most common being slapping or shaking the victim (an average of 2.5 minutes after overdose was first recognised) or walking the person around the room (3.2 minutes after recognizing overdose). There was no consistent relationship between the time taken to acting and the number of actions taken. Successful resolution of last witnessed overdose was associated more strongly with immediate onset of overdose, while those that led to death were more often those that involved slow onset of overdose. There is clear evidence of the opportunity and willingness of witnesses to intervene, particularly when overdose onset is immediate, with a wide range of strategies adopted to encourage recovery, although these may often be inappropriate and wrongly prioritized. [Best D, Gossop M, Lan-Ho M, Stillwell G, Coomber R, Strang J. Peer overdose resuscitation: multiple intervention strategies and time to response by drug users who witness overdose. Drug Alcohol Rev 2002;21:269±274] Key words: multiple strategies, overdose interventions, witnessed overdose. Introduction In the United Kingdom, as in many other countries, overdose is currently the main cause of death among opiate addicts and is likely to remain so for the foreseeable future [1,2]. In Scotland, drug-related deaths rose from 139 in 1994 to 227 in 1999, of which 163 involved heroin or morphine[3]. Similarly, Neele- man et al. reported that poisoning deaths in England and Wales involving heroin or methadone increased 10-fold between 1974 and 1992 [4]. Among adoles- cents in the United Kingdom, opiate overdose is now the most common cause of death [5]. Significant morbidity is also associated with non-fatal over- doses[6,7]. In a sample of London drug users, 38% reported having overdoses at some point in their lives, of whom a few had overdosed 10 times or more[8]. Most overdoses occur in the overdose victim’s home or in a friend’s home and, often, in the presence of someone else who could potentially intervene[9,10]. There is considerable scope for intervention when overdoses are witnessed. In a study by Strang et al., 92% of patients at a methadone clinic and over half the injectors recruited from non-treatment settings said they had witnessed an overdose and a quarter had done so in the past year. Twenty-nine percent and 18%, respectively, had seen a fatal incident. Of those who had overdosed, for about 80% the last occasion was in their own or a friend’s home and about the same proportion were in company [8]. Even the relatively inexperienced heroin users in one UK study had a reasonably high chance of witnessing an overdose[11]. However, the efficacy of the witness depends not only on their willingness to intervene but ISSN 09595236 print/ISSN 14653362 online/02/03026906 © Australian Professional Society on Alcohol and Other Drugs DOI: 10.1080/0959523021000002732 Drug and Alcohol Review (2002) 21, 269274